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This Week in JAMA
July 9, 2008

This Week in JAMA

JAMA. 2008;300(2):141. doi:10.1001/jama.2008.42

Androgen deprivation therapy is often used as an adjunct to surgery or radiation for patients with high-risk prostate cancer. However, some evidence suggests that patients with localized prostate cancer are receiving primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management. In a population-based cohort study of men aged 66 years or older and who did not receive definitive local therapy for clinical stage T1-T2 prostate cancer, Lu-Yao and colleagues assessed the relationship between PADT and conservative management and prostate cancer–specific survival or overall survival. The authors report that PADT was associated with worse 10-year prostate cancer–specific survival and no improvement in overall survival compared with conservative management.

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High levels of fetuin-A—a circulating hepatic protein that binds insulin receptors in muscle and fat and inhibits insulin action in vitro—have been associated with insulin resistance in cross-sectional studies. However, whether elevated levels of fetuin-A are associated with incident diabetes is not known. In a case-cohort study of Medicare beneficiaries who were participants in the Health, Aging, and Body Composition study (an observational study of changes in body composition and health), Ix and colleagues retrospectively measured baseline serum fetuin-A levels in a random sample of study participants without prevalent diabetes and from additional study participants who developed diabetes during a 6-year follow-up. The authors found that higher levels of fetuin-A at baseline were associated with incident diabetes and that this relationship was independent of physical activity, inflammatory biomarkers, and other common measures of insulin resistance.

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The Medicare Prescription Drug, Improvement and Modernization Act of 2003 reduced physician reimbursement for outpatient chemotherapy drugs. Some anecdotal reports suggested this change may have had adverse effects on Medicare beneficiaries' access to chemotherapy. In an analysis of a nationally representative sample of Medicare claims for patients receiving chemotherapy in 2003-2006, Shea and colleagues compared days from cancer diagnosis to first chemotherapy visit (“wait time”) and distance traveled for treatment before and after the bill's enactment. The authors found small—but likely clinically insignificant—increases in chemotherapy wait times and travel distances for Medicare beneficiaries in 2004, 2005, and 2006 compared with 2003, the year before the changes in reimbursement.

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In a meta-analysis of data from 16 population-based cohort studies that assessed longitudinally the ankle brachial index (ABI) and incidence of cardiovascular disease (CVD) events and mortality, investigators from the Ankle Brachial Index Collaboration found that the ABI provides information on the risk of cardiovascular events and mortality independent of that provided by the Framingham Risk Score. For example, the authors report that a low ABI (≤0.90) was associated with approximately twice the 10-year mortality and major coronary event rate as the overall rate in each Framingham category.

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“The differences in language used by most physicians and patients can impede communication, a key component of optimal care.” From “A Medical Humanist Says Good-bye.”

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Recent studies involving patients with cancer demonstrate that identifying the factors that influence an individual's response to medications can help guide cancer treatment.

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Global medical humanitarianism

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Health policy and public trust

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Patients searching the Internet for information about physicians

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How would you manage a 50-year-old woman with a long history of heroin use now being treated with methadone maintenance who wants to return to school to become a role model for her children and grandchildren? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is July 14.

Join Sherita Hill Golden, MD, MHS, July 16 from 2 to 3 PM eastern time to discuss the bidirectional association between depressive symptoms and diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about prostate cancer.

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